جستجوی مقالات مرتبط با کلیدواژه « utilization » در نشریات گروه « پزشکی »

An increase in the use of oral and dental health services and routine examinations can lead to better health and improve health equity indicators. This study aimed to analyze the factors affecting the utilization of oral and dental health services in the households of Ahvaz in 2022.

The present study is a cross-sectional descriptive-analytical study in which 715 households including 2680 people living in the city of Ahvaz were studied by using the stratified-cluster sampling method. The collection of the required data was performed through a questionnaire, and the logistic model and Stata software were used to analyze the data and estimate the elasticity of the influencing factors.

According to the results of this study, the utilization rate of oral and dental health services is 80.55%, and the odd ratio of the utilization of these services is 0.26% less for women compared to men, which is a statistically significant result. People with tertiary education also have a 1.83 times higher chance compared to other people to receive the services, which is statistically significant. People with income but without work have a 0.29 lower chance of receiving these services compared with unemployed people, although this result is not significant. Furthermore, people who have private insurance have 5.84 times more chances to receive these services, and this result is completely significant. Also, the individuals who exercise less than 3 times a week have the chance of receiving these services by 1.25 times compared to people who do not exercise at all, which is a significant result.

Based on the results of this study, it can be mentioned that employment and household income status, increased insurance coverage, higher education level, and a healthy lifestyle, including engaging in physical exercise, increase the chance of benefiting from dental services.

Knowledge about health care utilization and its determinants are important for health care planning. Andersen’s behavioral model of health services use is one of the most widely acknowledged models identifying predictors of health care utilization is the. According to Andersen’s model, factors associated with utilization of health services include predisposing factors, enabling factors, and need factors (health status). The purpose of this study is to identify the factors related to the utilization of inpatients health services in Iran, according to the Andersen’s behavioral model.

The present study is a secondary analysis of two waves of the Utilization of Health Services Survey conducting in the years of 2007 and 2015. The samples were 8326 and 5684 in 2007 and 2015, respectively. The Logistic regression model was used to analyze utilization of inpatient health services.

It was found that women (OR=1/48, P-value≤0/01), older patients (OR=1/01, P-value≤0/05), referral patients (OR=1/98, P-value≤0/01), those living in a household with a head educated more than diploma(OR=1/65, P-value≤0/01), and patients living in deprived areas of the country (OR=1/42, P value≤0/01) were more likely to use inpatient services. Furthermore, the odd of using inpatient health services were higher in the year of 2015 (OR=2/15, P-value≤0/01).

Andersen’s Behavioral Model of Health Services can be a good theoretical framework to explain the determinants of inpatient health services utilization in Iran. These factors should be considered for making policies related to inpatient health services in Iran.

This study aimed to assess the trends in management and in-hospital mortality of patients admitted with cardiogenic shock complicating ST-segment elevation myocardial infarction (STEMI-CS) between 2009 and 2018, and its association with new therapeutic modalities.

In this retrospective study, all patients with STEMI-CS from 2009 to 2018 in Shahid Madani Heart Center in northwest of Iran were enrolled (n = 410). Patients were classified into two five-year periods based on the year of admission, 162 patients in the first period (2009-2013) and 248 patients in the second period (2014-2018) were included in this study. Demographic data, risk factors, clinical symptoms, treatment strategies, and in-hospital mortality were compared between the two periods.

Therapeutic approaches including thrombolysis, percutaneous coronary intervention (PTI), coronary artery bypass grafting (CABG), and intra-aortic balloon pump were similar between two periods, and the only significant difference in treatment was the higher rate of using glycoprotein IIb/IIIa inhibitor in the second period (20.2% vs. 43.9%, respectively; P = 0.001). However, higher in-hospital mortality rate was found in 2009-2013 period compared to 2014-2018 period (80.8% vs. 69.7%, respectively; P = 0.010). Multivariate regression analysis showed that only coronary revascularization, either percutaneous or CABG, were independently associated with a lower mortality risk (Odds ratio of 0.26 and 0.21, respectively; P < 0.001 for both).

The results of this study showed that the therapeutic approaches in patients with STEMI-CS did not improve significantly over one decade, and most patients did not undergo coronary revascularization.

 Considering the rapid growth of Iran’s elderly population with consequent increase in the costs of health services, it is necessary to be aware of the pattern of outpatient health service utilization, in the elderly for resource allocation and health planning. This study aims to determine the pattern of outpatient service utilization for the elderly in Iran and explore determinant factors.

This is a cross-sectional study using secondary analysis method and the data from 2015 National Study of Health Service Utilization. Study population consists of older people aged ≥60 years. Of these, 8205 were selected as study samples. The data were collected using personal and household questionnaires collecting information on subjects’ need for, referral to, utilization from, and satisfaction with outpatient services. Logistic regression analysis was used to identify factors related to the need, referral, benefit, and satisfaction with the received outpatient services.

 Out of 8205 participants, 3172 (39%) reported the need for outpatient services, of which 66% referred for services; of these, 98% (N=2060) benefited outpatient services. Females, older subjects, villagers, unmarried and illiterate subjects were more in need of outpatient services, but their referrals to receive the services were not more than those of other groups. Lack of basic insurance, supplementary insurance, and a personal care had a significant impact on reducing the number of subjects referred to receive outpatient services. Inability to pay treatment costs (30%), self-treatment (28%) and lack of proper insurance coverage (13%) were the most important reasons for not referring to receive outpatient services. The highest satisfaction was related to the behavior of physicians and medical staff and the lowest satisfaction was related to the cost of outpatient services.

 Although the use of outpatient health services should be based on the need for these services, the present study showed that the older people with higher socio-economic status had higher utilization from the services in Iran. Therefore, there is an inequality in access to outpatient services in the elderly. The reasons for not using outpatient services and dissatisfaction with these services should be seriously considered by health policy makers.

Down syndrome is a common genetic disorder in which, due to the high prevalence of developmental, anatomical, and functional disorders associated with the oral cavity, it causes problems in maintaining oral hygiene. This study aimed to investigate the barriers to studentschr('39') oral health with Down syndrome from the perspective of their mothers.

In this qualitative study, in order to explain the barriers in promoting the oral health of students with Down syndrome from the perspective of their mothers, based on goal-based sampling, 21 semi-structured individual interviews were conducted to analyze the content of the interview. We analyzed interviews by Graneheimor and  Lundman qualitative approaches.

According to motherschr('39') experiences, their childrenchr('39')s disorders can be an obstacle to achieving good oral health. From the data analysis, the three main themes are "the effects of general health status, the effects of instruction and learning, problems in receiving dental health care services." Moreover, six sub-themes were extracted: "General Health, Oral and Dental malformations, Mother learning, learning of people with Down syndrome, Problems with Down Syndrome People, and Service receiving problems.”

Given that these childrenchr('39')s illness is an essential obstacle to receiving dental services, stakeholders in planning should pay special attention to providing dental services to these children.

 Demographic and epidemiological changes in the 21st century have created new challenges such as aging and the rising trend of non-communicable diseases. The high prevalence of disability (due to the growing aging population), non-communicable diseases, and accidents have increased the demand for rehabilitation services. However, there are not enough resources to meet all current needs in many parts of the world. The purpose of this study is to investigate the inequality in the utilization of rehabilitation services between Iranian households in urban and rural areas.

This is a descriptive-analytical study with a cross-sectional design using the household expenditure, income survey data from the Statistics Center of Iran in 2018. The used instrument was a questionnaire surveying the expenditure and income of urban and rural households (social characteristics of household members, place of residence and main living facilities, food/non-food expenses, and household income), which was completed through interviewing the household head or a member over 15 years of age. The study samples were 18610 households in rural areas and 20348 households in urban areas. After extracting and refining the data, 38958 households were included in the study. Factors affecting their utilization of rehabilitation services and the inequality in utilization were analyzed using the Chi-square test and the concentration index (CI), respectively. Data were extracted in MS Access 2013 and MS Excel 2013 applications and were analyzed in STATA V.14.1 software. The geographic distribution of the service utilization was plotted using ArcGIS Map V. 10 software.

 A total of 258 households (0.77%) used rehabilitation services. Of these, 226 (87%) had a male head, and 32 (13%) had a female head. About 60% had 3-4 members, and 239 (92%) had insurance coverage, and others (8%) had no insurance coverage. Also, 173 (67%) had an employed head. Finally, 55% were living in rural areas, and 45% in urban areas. Uninsured households had less use of rehabilitation services (P<0.05). Also, 1.32% of the fifth income quintile (highest income) used rehabilitation services, while this rate was 0.35% for households in the first quintile (P<0.001). Zanjan, Qazvin, Khuzestan, Isfahan, Lorestan, Bushehr, and Semnan provinces had the lowest service utilization rates in urban/rural areas and the whole country. Qom province had a better status regarding service utilization in urban areas, while East Azerbaijan, Mazandaran, Golestan, Yazd, Fars, and Hormozgan provinces had higher service utilization rates in rural areas. Overall, East Azerbaijan, Mazandaran, and Qom provinces had a higher rate of utilization. The CI value for the whole country was reported at 0.24 (95% CI: 0.17-0.30), indicating a higher inequality in utilization in favor of the rich. The CI values for rural and urban areas were 0.27 and 0.19, respectively (P<0.001).

There is inequality in the utilization of rehabilitation services in favor of the rich households in Iran, and low-income households have lower access to these services. The inclusion of rehabilitation services in the primary health insurance package with appropriate pricing and population coverage, and fair distribution of rehabilitation services following the needs of public and private sectors, can increase the access and utilization of rehabilitation services.

Health reform plan in dentistry has been implemented systematically in Iran since 2014 in villages and cities with a population lower than 20,000 inhabitants. This study aimed to evaluate the impact of this plan on the utilization of dental services in Isfahan province.

Ten health centers with dentists contracted with the health reform plan were recruited. The frequency of dental services (examination, preventive care, restorative care, and extraction) was assessed. Four centers not in contract with this plan were considered as the control centers. To compare the frequency of provided services, the non-parametric tests of Mann-Whitney and Wilcoxon (α=0.05) were used (SPSS 22).

In the control centers, the cumulative frequency of provided care demonstrated no significant difference between 2014 and 2017. In the centers subject to the reform plan, there were increases in examination (p=0.02), amalgam (p=0.04), and composite restoration (p=0.04) in the age group of 6 years, and examination, extraction, amalgam, and composite restoration (p=0.007) in the age group of 6-12 years. In pregnant women, extraction (p=0.017), composite restoration (p=0.04), and scaling (p=0.012) increased significantly. In the six-year-old group, the means difference of extraction (p=0.036) and amalgam restoration services (p=0.024) and in the age group of 6-12 years, the means of extraction (p=0.014) and amalgam restoration (p=0.008) were significantly increased in the centers subject to the reform plan than in the control group.

After the implementation of the reform plan in health centers, dentists were more willing to provide preventive and restorative care that could be partially due to financial incentives.
 

This study aimed to determine the perceived need, seeking, and utilization of health services among eight-year-old or younger children with disabilities in Iran.

This descriptive cross-sectional study was conducted on a sample of 2,000 children with disabilities aged eight years or lower selected through multistage sampling from five provinces of Iran. Data were collected using a researcher-made electronic questionnaire. Descriptive statistical methods were used to analyze the data by Stata 13.

The highest percentages of perceived needs for outpatient services in the last three months belonged to specialist physician visits (65.80%), medication (66.05%), speech therapy (57.58%), and occupational therapy (54.89%). The lowest percentages of seeking for perceived needs belonged to dental services (45.80%), psychiatry services (51.30%), and physiotherapy services (60.69%). The lowest percentages of utilization after seeking for perceived needs belonged to dental services (61.00%), physiotherapy services (82.38%), and outpatient surgery services (86.40%). The percentages of perceived need, seeking, and utilization of inpatient services over the past 12 months were reported to be 22.08%, 88.73%, and 87.89%, respectively.

There was a significant difference between perceived need, seeking, and utilization of health services in children with disabilities in Iran. Health system policymakers should consider the factors affecting the seeking and utilization of health services by children with disabilities in designing appropriate interventions.